Job Description
Job Title: HEDIS Review Nurse
Client: Managed Care Company/Health Insurance
Location: 100% remote
Target Duration: January 2025 - April or May 2025
Work Schedule: Monday-Friday (usual business hours on CST)
Pay rate: May vary depending on the license and HEDIS experience
Requirement: To complete an online assessment (Basic MS Excel & Typing Test prior submission to the client)
SUMMARY DESCRIPTION:
An RN and LPN(LVN) responsible for annual patient chart inspection/audit. Audits are conducted to ensure that providers (MDs) accepting insurance are in compliance with standards of patient care set forth by the insurance company. Experience with medical record review required.
ESSENTIAL FUNCTIONS:
1. Apply structured auditing criteria to abstract medical records, follow defined procedures for saving approved medical record documentation and accurately enter the results of chart audits into the healthplans database, Quality Spectrum Hybrid Reporter (QSHR).
2. Abstract medical record documentation submitted for HEDIS measures, used annually for reporting to National Committee for Quality Assurance (NCQA). The HEDIS measures are used to assist in measuring quality of health care provided to healthplan members.
3. Maintains productivity level with less than a 5% error rate in record abstraction and data entry on an ongoing basis.
4. Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.
5. Maintain complete confidentiality of company related business.
6. Maintain effective communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.
JOB REQUIREMENTS:
Company Description
W3R Consulting is a Southfield, Michigan based staffing and consulting firm that provides talent, technology consulting and advanced analytics solutions to Fortune 500 companies in the automotive, financial, healthcare, insurance, professional and business services, and retail industries. In 2012, w3r acquired Nurse Now Staffing. inner of numerous customer and industry awards, this year W3R celebrates 22 years of innovation, exceptional customer service and community engagement.
W3R Consulting is a Southfield, Michigan based staffing and consulting firm that provides talent, technology consulting and advanced analytics solutions to Fortune 500 companies in the automotive, financial, healthcare, insurance, professional and business services, and retail industries. In 2012, w3r acquired Nurse Now Staffing. inner of numerous customer and industry awards, this year W3R celebrates 22 years of innovation, exceptional customer service and community engagement.
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